Current hearing-screening tests are useful in identifying individuals with hearing loss, but they are not designed to motivate follow-up with audiologists for hearing evaluation. For Aim 1 of the R21 study, we will develop a 5-module software suite for community-based automated hearing screening with the goal of providing: 1) low-cost hearing screening with education about hearing and hearing loss;2) an abbreviated pure-tone audiogram using the Automated Method for Testing Auditory Sensitivity (AMTAS);3) counseling on the results;4) a demonstration of hearing-aid processed speech designed to motivate interest in treatment;and 5) recommendations for follow up. We will then add two additional hearing screening tests in Aim 2: a pure-tone screening at a fixed level of 40 dB HL;and a digits-in-noise test. The pure-tone screening test will be developed with a simple modification of the AMTAS program. We will adapt the digits-in-noise test designed for telephone-based hearing screening in the United States (Watson et al. 2010) for use under headphones in a computer kiosk. The main goal of the R33 study is to conduct a randomized clinical trial of community-based hearing screening with 4 arms: control (no screening);screening with the 5-module software suite;a pure-tone screening at a fixed level;and the digits-in-noise test. A total of 2400 subjects will be screened in the trial at four sites: Community-based Outpatient Clinics (CBOCS) in Portland, OR, and Bay Pines, FL;community centers in Minnesota and Wisconsin;and community centers and health fairs in Columbus, OH. It is hypothesized that the 5-module screening and education suite will motivate greater follow up with an audiologist for a hearing test at 6 months than pure-tone screening alone or the digits-in-noise test alone. Secondary analyses will concern hearing aid uptake, baseline communication ability, and demographics such as insured or not insured;VA or non-VA, and urban versus rural to examine issues of access to hearing health care through screening. We will also conduct a pilot study in which the 5-module suite is loaded on a CD and packaged with earphones and a sound card for a Home Hearing Test. If shown successful in a clinical trial, this method of automated hearing screening could greatly expand access to affordable hearing screening that motivates individuals to enter the hearing healthcare system in this country. Eventual application on the internet could truly make automated hearing screening an affordable and effective reality. PUBLIC HEALTH RELEVANCE: We will develop a 5-module automated hearing screening kiosk designed to motivate those who fail screening to follow up with a hearing test. This will be tested in a randomized clinical trial with four arms: control (no screening);5-module automated screening;simple pure-tone screening;and digits-in-noise screening. We also will examine how results vary for participants from different geographical and demographic backgrounds.